Provider Demographics
NPI:1497710586
Name:PLETZ, MARK LOCHRIDGE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOCHRIDGE
Last Name:PLETZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 DENMARK AVE
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2257
Mailing Address - Country:US
Mailing Address - Phone:651-405-0942
Mailing Address - Fax:651-405-3837
Practice Address - Street 1:3035 DENMARK AVE
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2257
Practice Address - Country:US
Practice Address - Phone:651-405-0942
Practice Address - Fax:651-405-3837
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU11076Medicare UPIN